Eliciting test-selection strategies for a decision-support system in oncology

Contains fulltext : 56813.pdf (publisher's version ) (Open Access

Automated Test Selection in Decision-Support Systems: a Case Study in Oncology

Decision-support systems in medicine should be equipped with a facility that provides patient-tailored information about which test had best be performed in which phase of the patient's management. A decision-support system with a good test-selection facility may result in ordering fewer tests, decreasing financial costs, improving a patient's quality of life, and in an improvement of medical care in general. In close cooperation with two experts in oncology, we designed such a facility for a decision-support system for the staging of cancer of the oesophagus. The facility selects tests based upon a patient's health status and closely matches current routines. We feel that by extending our decision-support system with the facility, it provides further support for a patient's management and will be more interesting for use in daily medical practice. In this paper, we describe the test-selection facility that we designed for our decision-support system in oncology and present some initial result

Eliciting Test-selection Strategies for a Decision-Support System in Oncology

Decision-support systems often include a strategy for selecting tests in their domain of application. Such a strategy serves to provide support for the reasoning processes in the domain. Generally a test-selection strategy is offered in which tests are selected sequentially. Upon building a system for the domain of oesophageal cancer, however, we felt that a sequential strategy would be an oversimplification of daily practice. To design a test-selection strategy for our system, we decided therefore to acquire knowledge about the actual strategy used by the experts in the domain and, more specifically, about the arguments underlying their strategy. For this purpose, we used an elicitation method that was composed of an unstructured interview to gain general insight in the test-selection strategy used, and a subsequent structured interview, simulating daily practice, in which full details were acquired. We used the method with two experts in our application domain and found that the method closely fitted in with their daily practice and resulted in a large amount of detailed knowledge

Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study

Purpose: To investigate prevalence, independent associations, and variation over time of potentially inappropriate prescriptions in a population of older hospitalized patients. Methods: A longitudinal study using a large dataset of hospital admissions of older patients (≥ 70 years) based on an electronic health records cohort including data from 2015 to 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) prevalence during hospital stay were identified based on the Dutch STOPP/START criteria v2. Univariate and multivariate logistic regression were used for analyzing associations and trends over time. Results: The data included 16,687 admissions. Of all admissions, 56% had ≥ 1 PIM and 58% had ≥ 1 PPO. Gender, age, number of medications, number of diagnoses, Charlson score, and length of stay were independently associated with both PIMs and PPOs. Additionally, number of departments and number of prescribing specialties were independently associated with PIMs. Over the years, the PIM prevalence did not change (OR = 1.00, p =.95), whereas PPO prevalence increased (OR = 1.08, p <.001). However, when corrected for changes in patient characteristics such as number of diagnoses, the PIM (aOR = 0.91, p <.001) and PPO prevalence (aOR = 0.94, p <.001) decreased over the years. Conclusion: We found potentially inappropriate prescriptions in the majority of admissions of older patients. Prescribing relatively improved over time when considering complexity of the admissions. Nevertheless, the high prevalence shows a clear need to better address this issue in clinical practice. Studies seeking effective (re)prescribing interventions are warranted

Potentially inappropriate medications and their effect on falls during hospital admission

OBJECTIVE: to investigate the effect of potentially inappropriate medications (PIMs) on inpatient falls and to identify whether PIMs as defined by STOPPFall or the designated section K for falls of STOPP v2 have a stronger association with inpatient falls when compared to the general tool STOPP v2. METHODS: a retrospective observational matching study using an electronic health records dataset of patients (≥70 years) admitted to an academic hospital (2015-19), including free text to identify inpatient falls. PIMs were identified using the STOPP v2, section K of STOPP v2 and STOPPFall. We first matched admissions with PIMs to those without PIMs on confounding factors. We then applied multinomial logistic regression analysis and Cox proportional hazards analysis on the matched datasets to identify effects of PIMs on inpatient falls. RESULTS: the dataset included 16,678 hospital admissions, with a mean age of 77.2 years. Inpatient falls occurred during 446 (2.7%) admissions. Adjusted odds ratio (OR) (95% confidence interval (CI)) for the association between PIM exposure and falls were 7.9 (6.1-10.3) for STOPP section K, 2.2 (2.0-2.5) for STOPP and 1.4 (1.3-1.5) for STOPPFall. Adjusted hazard ratio (HR) (95% CI) for the effect on time to first fall were 2.8 (2.3-3.5) for STOPP section K, 1.5 (1.3-1.6) for STOPP and 1.3 (1.2-1.5) for STOPPFall. CONCLUSIONS: we identified an independent association of PIMs on inpatient falls for all applied (de)prescribing tools. The strongest effect was identified for STOPP section K, which is restricted to high-risk medication for falls. Our results suggest that decreasing PIM exposure during hospital stay might benefit fall prevention, but intervention studies are warranted